Browsing by Author "Pokhrel, BM"

Now showing 1 - 8 of 8
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    Assessment of Health Systems in Relation to Interface Between Malaria Control Programs and Health System Strengthening: Comparative Study Between Nepal and Viet Nam
    (Institute of Medicine, 2015) Oraha, H; Sherchan, JB; Pokhrel, BM; Hirayama, T; Huy Nam, Vu; Sherchand, JB
    Abstract Introduction: Malaria control has been a major health issue with high priority in endemic countries and various efforts have been made with the support of foreign assistant partners. In order to implement efficient and sustainable control, integration of the control program into general health system or effective interactions between them is one of the important strategies. Methods: Studies were conducted in Nepal and Viet Nam. Information obtained from document reviews, interviews, and field surveys were analyzed from the viewpoint of interface between malaria control program and the health system in accordance with six building blocks of a health system, with special emphasis on good practices and challenges in the implementation of the malaria control program. Results: Among good practices, strong government commitment towards the control programs to strengthen facilities and capacity of health workers at the primary level, utilization of health volunteers, setting up mobile team and intensified education for residents were noteworthy. Key challenges mainly involved remote areas. Introduction of malaria due to population movement and the emergence of new endemic areas have become growing issues. While strengthening of the vertical health program appeared to have some impact on the general health system, particularly at the primary level, dissociation between the vertical control program and horizontal general health system still remains. Conclusion: It is crucial to implement an effective and equitable malaria control program that responds to these existing challenges and can create a sustainable health system. Addressing these issues will lead to further strengthening of the health system there and eventually lead to the effective implementation of various health programs. Keywords: malaria control, health system, Nepal, Veit Nam
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    Co-existence of aminoglycosides and β-lactam-resistant Escherichia coli phenotypes in a Tertiary care center of Nepal
    (Institute of Medicine, 2015) Shrestha, B; Tada, T; Shrestha, S; Katte, HPl; Ohara, H; Kirikae, T; Rijal, BP; Sherchand, JB; Pokhrel, BM
    Abstract Introduction: Multidrug-resistant Escherichia coli isolates conferring simultaneous resistance to both aminoglycosides and β-lactam drugs have serious implications for clinicians worldwide. This study was designed to evaluate the co-existence of various β-lactamases in aminoglycoside- resistant Escherichia coli amongst hospitalized subjects in a tertiary care center of Kathmandu, Nepal, between December 2013 and December 2014. Methods: Standard microbiological techniques were used for isolation and identification of the isolates. The antimicrobial susceptibility of bacterial isolates was determined following Clinical and Laboratory Standard Institute recommended Kirby-Bauer Disc Diffusion method. The defining criterion in this study for an isolate to be MDR, resistance to at least one agent in three or more than three different structural classes was taken. Results: Among 302 MDR E. coli isolates, 174 (58.0 %) were resistance to gentamicin and 138 (46.0 %) were resistance to amikacin. Maximum aminoglycoside-resistant 9/11(82.0%) strains were isolated from body fluids followed by 7/10 (70.0%) from bile, 6/9 (67.0%) from blood and 2/3 (67.0%) from tissue. Out of 174 aminoglycosides-resistant E. coli isolates, the simultaneous occurrence of Extended-spectrum- b- lactamase (ESBL) and AmpC β–lactamaseswas noted in 13.0 % isolates and Metallo-β-lactamase (MBL) and AmpC β–lactamasesin 8.0 % isolates. None E. coli isolates were positive for all 3 types of β–lactamases in combinations. In amikacin- resistant isolates, ESBL+ AmpC observed in 12% and MBL+AmpC seen in 10% isolates. Conclusion: Our results show a high frequency of aminoglycoside- resistance phenotypes. Strict application for appropriate use of antimicrobials in medical settings should be essential to minimize the emergence of multidrug-resistance among E. coli in hospitalized patients. Keywords: Aminoglycoside-resistant E. coli, Amp C β–lactamases, Metallo-β-lactamase, MDR E.coli
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    Nosocomial Bacterial Infection and antimicrobial Resistant Pattern in a Tertiary care Hospital in Nepal
    (Institute of Medicine, 2014) Sah, MK; Mishra, SK; Ohora, H; Kirikae, T; Sherchan, JB; Rijal, BP; Pokhrel, BM
    Abstract Introduction: Nosocomial infection is a global problem with multi facet outcomes. At present, the emergence of resistance to antimicrobial agents is a global public health problem which is well pronounced in developing countries. Methods: The aim of this study was to determine the prevalence of bacteria causing nosocomial infections and their antibiotics resistant pattern among the patients admitted at Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal. The study was conducted during a period of March 2011 to February 2012. Nine hundred clinical specimens which included urine, sputum, endotracheal aspirates, pus & blood were subjected for bacterial culture and their antibiotics sensitivity test at the Department of Microbiology with the use of standard method as described by American Society for Microbiology (ASM). Results: Prevalence of bacteria causing nosocomial infection was 34.4% (n=310). Out of 310 specimens, urine 122 (39.30%), sputum 78(25.2%), pus 78(25.2%), endotracheal secreation 24 (7.7%) and blood 8(2.6%). Three hundred thirty three bacteria were isolated from three hundred ten specimens. The most common isolates were Escherichia coli followed by Acinetobacter species, Klebsiella pneumonia and Staphylococcus aureus. In-vitro antibiotic susceptibility tests revealed that the Gram-negatives bacilli were only sensitive to fluroquinolones, ceftrixone, cefepime carbapenem, polymyxin B and colistin sulphate while the Gram-positive cocci were sensitive to fluroquinolones, Ceftroxone, cefepime and vancomycin. Conclusion: The findings suggested the need for constant monitoring of susceptibility of specific pathogens in different populations to commonly used anti-microbial agents to cope up this alarming situation in the hospital for the management of such patients and prevent the dissemination of such strains. Keywords: noscomical infections, bacteria and antibiotics
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    Paragonimiasis: First autochthonous case report from Nepal
    (Institute of Medicine, 2016) Sah, R; Khadka, S; Sherchand, JB; Parajuli, K; Shah, NP; Mishra, SK; Sharma, S; Shrestha, L; Basnet, S; Tandukar, S; Bhandari, D; Yadav, SR; Kattel, HP; Pokhrel, BM; Rijal, B
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    Phenotypic characterization of multidrug-resistant Acinetobacter baumannii with special reference to metallo-β-lactamase production from the hospitalized patients in a tertiary care hospital in Nepal
    (Institute of Medicine, 2015) Shrestha, S; Tada, T; Shrestha, B; Ohara, H; Kirikae, T; Rijal, BP; Pokhrel, BM; Sherchand, JB
    Abstract Introduction: Acinetobacter baumanniiis an important cause of nosocomial infection and has been associated with a wide variety of illnesses in hospitalized patients, especially patients in the intensive care units. The emergence of carbapenem-resistant clones of A. baumannii has been the most serious problem worldwide. After the carbapenem resistant clones have emerged, leaving the hope of treatment of A. baumannii infection is by the last resort of antibiotics such as tigecycline, polymyxin-B and colistin. The purpose of this study is to determine the antibiotic resistance patterns of A. baumannil isolates, prevalence of multidrug resistance, extended spectrum beta lactamase production and metallo-beta lactamase production. Methods: This is a prospective study conducted at the department of Clinical Microbiology. Tribhuvan University Teaching Hospital, from December 2013 to September 2014. Ethical approval was taken from the Institutional Review Board of Institute of Medicine. Two hundred and forty six Acinetobacterisolates were identified by standard microbiological testing. Antimicrobial susceptibility testing was performed by Kirby Bauer method as per the CLSI guidelines. Multidrug resistance was determined. ESBL production was detected by combination disc method and confirmed by Clinical and Laboratory Standerd Institute confirmatory test. MBL production was detected by using imipenem and imipenem/EDTA disc. Result: All 122 Multidrug-resistant A. baumannii isolateswere resistant to majority of the drugs used. All the isolates were completely sensitive to polymyxin B, colistin and tigecycline only. Fifteen (12.29%) isolates of A. baumannii were extended spectrum beta-lactamase producers and 50 (40.98%) were metallo-beta-lactamase producers. Multidrug resistance was common in A. baumannii Conclusion: Multidrug resistance in A. baumannii is becoming more common ESBL and MBL production should be promptly detected and reported to control the spread of resistant phenotypes to other individuals. Keywords: Acinetobacter baumannii, ESBL, MBL, multidrug-resistance
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    Prevalence of nosocomial lowerrespiratory tract infections caused by Multi-drug resistance pathologens
    (Institute of Medicine, 2011) Shrestha, S; Chaudhari, R; Karmacharya, S; Kattel, HP; Mishra, SK; Dahal, RK; Bam, N; Banjade, N; Rijal, BP; Sherchand, JB; Ohara, H; Koirala, J; Pokhrel, BM
    Abstract Introduction: Nosocomial infections caused by multi-drug resistant pathogens are major threat to the hospitalized patients. Extended spectrum beta-lactamase (ESBL) and metallo-beta-lactamase (MBL) producing bacterial strains causing hospital acquired lower respiratory tract infection are increasing in numbers. Only a limited number of studies related to MBL producers have been done in Nepal. Objective: The goal of this study was to determine the etiology of nosocomial lower respiratory tract infections and to assess the current levels of antimicrobial resistance with special reference to ESBL and MBL producing bacterial strains. Methods: A total of 100 specimens including sputum and endotracheal secretion from patients diagnosed of nosocomial lower respiratory tract infection were collected and processed according to the standard methodology. Combination disk method was done for the detection of ESBL and MBL producing isolates. Results: Out of total 100 specimens, 87% was monomicrobial while the rest were polymicrobial. 96.5 % were gram negative while 3.5% were gram positive. All E.coli, Klebsiella spp and S. aureus were found to be MDR followed by Acinetobacter spp (97.2%) and P. aeruginosa (76.2%) About 28.6 % of E. coli, 8.33% of Klebsiella spp and 2.4 % of Pseudomonas aeruginosa were ESBL producers. Acinetobacter spp. was not found to produce ESBL during the study. MBL was present in 17.4% of the gram negative isolates. Conclusion: We found a high prevalence of MDR strains as a cause of nosocomial LRTI including significant proportions of ESBL and MBL producers. The rate of Acinetobacter spp., including MBL producers, in our hospital setting was alarmingly high which prompts a special attention for the management of such patients as well as urgent need for implementation of infection control strategies. Keywords: MDR, LRTI, ESBL, MBL, nosocomial infection
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    Ventilator Associated Pneumonia in Tertiary Care Hospital, Maharajgunj, Kathmandu, Nepal
    (Institute of Medicine, 2013) Shrestha, RK; Dahal, RK; Mishra, SK; Parajuli, K; Rijal, BP; Sherchand, JB; Kirikae, T; Ohara, H; Pokhrel, BM
    Abstract Introduction: Ventilator Associated Pneumonia (VAP) is the most common nosocomial infection among intensive care unit (ICU) patients and lack of much information in Nepal. So, the aim of this study was to determine prevalence and bacteriological profile of VAP with special reference to multi-drug resistant (MDR), Methicillin-resistant Staphylococcus aureus(MRSA), Metallo-β-Lactamase(MBL), Extended-Spectrum β-Lactamase(ESBL)-producing bacterial strains. Methods: A total 150 tracheal specimens were studied during June 2011 to May 2012 at Department of Microbiology, TUTH as described by American Society for Microbiology (ASM). Combination disk method was done for the detection of ESBL and MBL producing isolates. Results: Prevalence of VAP was found to be 34%. Acinetobactereal coaccticusbaumannii complex (44%) was the commonest isolate, followed by Klebsiellapneumoniae (22%), Pseudomonas aeruginosa (16%) and Staphylococcus aureus (12%). Among MDR Gram negative bacteria (GNB), 39% were MBL and 33% were ESBL-producers. All GNB (61) were sensitive to Polymyxin B and Colistinsulphate, whereas, 48% were found resistant to Carbapenems. Prevalence of MRSA was 75%, which were all sensitive to Vancomycin. Conclusion: High prevalence of VAP, MDR along with MRSA or ESBL or MBL producing strains was found in the study. Thus, suitable control measures must be adopted to cope up this alarming situation with genetic characterization. Keywords: VAP, ICU, MDR, MRSA, ESBL, MBL

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